Hepatitis B

Topic Overview

What is hepatitis B?

Hepatitis B is a
virus that infects the
liver. Most adults who get it have it for a
short time and then get better. This is called acute hepatitis B.

Sometimes the virus causes
a long-term infection, called chronic hepatitis B. Over time, it can damage
your liver. Babies and young children infected with the virus are more likely
to get chronic hepatitis B.

You can have hepatitis B and not know it. You may not have symptoms. If
you do, they can make you feel like you have the flu. But as long as you have
the virus, you can spread it to others.

What causes hepatitis B?

It's caused by
the hepatitis B virus. It is spread through contact with the blood and body
fluids of an infected person.

You may get hepatitis B if
you:

Have sex with an infected person without
using a condom.

Share needles (used for injecting drugs) with an
infected person.

Get a tattoo or piercing with tools that weren't
sterilized.

Share personal items like razors or toothbrushes with
an infected person.

A mother who has the virus can pass it to her baby during
delivery. Medical experts recommend that all pregnant women get tested for hepatitis
B. If you have the virus, your baby can get shots to help prevent
infection with the virus.

You cannot get
hepatitis B from casual contact such as hugging, kissing, sneezing, coughing,
or sharing food or drinks.

What are the symptoms?

Many people with hepatitis
B don't know they have it, because they don't have symptoms. If you do have
symptoms, you may just feel like you have the flu. Symptoms include:

Feeling very tired.

Mild
fever.

Headache.

Not wanting to
eat.

Feeling sick to your stomach or vomiting.

Belly
pain.

Tan-colored bowel movements (stools).

Dark urine.

Yellowish eyes and skin (jaundice).
Jaundice usually appears only after other symptoms have started to go
away.

Most people with chronic hepatitis B have no
symptoms.

How is hepatitis B diagnosed?

A simple blood test
can tell your doctor if you have the hepatitis B virus now or if you had it in
the past. Your doctor also may be able to tell if you have had the vaccine to
prevent the virus.

If your doctor thinks you may have liver damage
from hepatitis B, he or she may use a needle to take a tiny sample of your
liver for testing. This is called a
liver biopsy.

How is it treated?

In most cases, hepatitis B goes
away on its own. You can relieve your symptoms at home by resting, eating
healthy foods, drinking plenty of water, and avoiding alcohol and drugs. Also,
find out from your doctor what medicines and herbal products to avoid, because
some can make liver damage caused by hepatitis B worse.

Treatment
for chronic hepatitis B depends on whether your infection is getting worse and
whether you have liver damage. Most people with chronic hepatitis B can live
active, full lives by taking good care of themselves and getting regular
checkups. There are medicines for chronic hepatitis B, but they may not be
right for everyone. Work with your doctor to decide if medicine is
right for you.

Sometimes, chronic hepatitis B can lead to
severe liver damage. If this happens, you may need a liver transplant.

Can hepatitis B be prevented?

The hepatitis B
vaccine is the best way to prevent infection. The vaccine is a series of 3 or 4
shots. Adults at risk and all babies, children, and teenagers should be
vaccinated.

A combination vaccine (Twinrix) that protects against
both hepatitis B and hepatitis A also is available.

To avoid
getting or spreading the virus to others:

Use a condom when you have
sex.

Don't share needles.

Wear latex or plastic gloves
if you have to touch blood.

Don't share toothbrushes or
razors.

Don't get a tattoo, or make sure that the needles used have been cleaned properly and are sterile.

Cause

Hepatitis B is
a liver disease caused by infection with the hepatitis B virus.

How hepatitis B is spread

The virus is spread when blood,
semen, or vaginal fluids (including menstrual blood)
from an infected person enter another person's body. This usually happens through:

Sexual contact. The hepatitis B virus can
enter the body through a break in the lining of the
rectum,
vagina,
urethra (the tube that carries urine out of the body), or mouth.

Sharing needles and other equipment (such as cotton,
spoons, and water) used for injecting illegal drugs.

Work tasks. People who handle
blood or instruments used to draw blood may become infected.
Health care workers are at risk of infection if they are
accidentally stuck with a used needle or other sharp instrument that has an infected person's blood on it. Infection
also can occur if blood splashes onto an exposed surface, such as the eyes, the mouth, or a cut in the
skin.

Childbirth. A newborn baby can get the virus from his or her
mother. This can happen during delivery when the baby comes in contact with the mother's body
fluids in the birth canal. But breast-feeding doesn't
spread the virus from a woman to her child.

Body
piercings and tattoos. The virus may be spread when needles used for body piercing or
tattooing aren't sterilized and infected blood enters a
person's skin.

Toiletries. Grooming items such as razors and
toothbrushes can spread the virus if they carry blood from a person who is infected.

In the past, blood transfusions were a common way of
spreading hepatitis B. Organ transplants could also spread the disease. Today, all
donated blood and organs in the United States are screened for the virus. So it
is extremely unlikely that you could become infected from a
blood transfusion or an organ transplant.

Contagious and incubation periods

Symptoms appear about 3 months after you
have contact with the virus (incubation period). But they can appear as soon as 2 months to as late as 5 months after contact. Blood, semen, and vaginal fluids,
whether fresh or dried, are highly contagious during
this period and for several weeks after the start of symptoms.

If you have a short-term (acute) infection, in most cases you
can't spread the virus after your body starts making a certain type of hepatitis B antibody.
This generally takes several
weeks. If you have a long-term (chronic) infection, you are able to spread
the virus as long as you have an active infection.

Symptoms

Most people who have an acute hepatitis B infection don't have symptoms. But if you do have symptoms, they may include:

Extreme tiredness (fatigue).

Mild
fever.

Headache.

Loss of appetite, nausea,
and vomiting.

Constant discomfort on the
right side of the belly under the rib cage. (That's where the liver is located.)

Tan-colored bowel movements (stools).

Dark urine.

Jaundice. This means that the skin and whites of the
eyes look yellow. Jaundice is a major sign of liver damage. It usually appears after other symptoms have started to go
away.

Most people who have chronic infection have no symptoms.

You may get infected without knowing it. You may not find out
that you have an infection until you have a routine blood test or donate
blood. Finding out that a family member or someone you live with is infected also
may cause you to be tested. Some people never know they have hepatitis B until
a doctor finds that they have
cirrhosis or
liver cancer.

What Happens

Most people who have hepatitis B have an acute
(short-term) infection.

They start to feel better after 2 to 3
weeks and recover completely after 4 to 8 weeks. They develop
antibodies to hepatitis B.
These antibodies provide lifelong protection against
future infection.

Only some people (mainly older adults)
have long-lasting symptoms.

A small number of people have symptoms
that last for months and sometimes years.

If you
stay infected with the virus for 6 months or longer, you have a chronic infection.

The risk of having chronic infection is related
to the age at which you first become infected. The risk is highest for newborns infected at birth and children up to age 5.

Many people who have chronic hepatitis B won't develop complications. But about 15
to 25 out of 100 people who have chronic infection will die of
cirrhosis or
liver cancer.1 (This means that 75 to 85 people out of 100 who have a chronic infection won't die of these diseases.) Having a lot
of virus in the body (a high viral load) increases the risk of getting
cirrhosis and liver cancer.

You are more likely to get cirrhosis if you
carry a certain hepatitis B antigen, are older than
40, and have high liver enzymes. For more information, see the topic Cirrhosis.

Risk factors for getting
liver cancer after chronic infection include being male, having a family
history of liver cancer, being over 40 years old, having cirrhosis, and also
having
hepatitis C.

Hepatitis D (delta) virus infection is a problem that can develop in relation to hepatitis B
infection, but it's not common. It occurs only in those with hepatitis B. And it may make that infection more
severe.

People who have hepatitis B who engage in high-risk behavior
(such as having multiple sex partners or injecting illegal drugs) are at
increased risk for hepatitis C. They also are at higher risk of getting
HIV, the virus that causes
AIDS.

What Increases Your Risk

People who have certain
behaviors or certain jobs are at high risk for becoming infected with
hepatitis B.

Job risk factors
include:

Handling blood or body fluids as a routine part
of your job. This includes health care workers, such as doctors, dentists,
nurses, and blood and lab technicians, and students in these
jobs. It also includes morticians and embalmers.

Being an
employee or resident of an institution for people who have developmental
disabilities.

Being an employee or inmate of a
prison.

Lifestyle risk factors include:

Being born in, or spending more than 6 months in, parts of the world where
hepatitis B is common or where a large number of people have been infected for
a long time. Such areas include Southeast and Central Asia, the
islands of the South Pacific, the Amazon River basin, the Middle East, Africa,
Eastern Europe, and China.

Being a man who has sex with men.

Being sexually active. This includes having
unprotected sex with someone who is infected with the virus or whose sexual
history is unknown to you.

Having more than one sex partner. (Your
risk is higher if you have another
sexually transmitted infection such as
chlamydia.)

Living with someone who has a chronic hepatitis B
infection.

Getting body piercings or tattoos from
someone who doesn't sterilize his or her equipment.

Sharing needles or other
equipment (such as cotton, spoons, and water) to inject illegal drugs.

Other factors include:

Being born to a woman who is infected with hepatitis B (if the newborn doesn't promptly receive the
hepatitis B vaccine and
hepatitis B immunoglobulin). But breast-feeding doesn't spread the virus to a child.

You have been bitten by or exposed to
the blood or body fluids (such as
semen or vaginal fluids, including menstrual blood) of
someone who has hepatitis B.

Watchful waiting

Watchful waiting is a period of time during
which you and your doctor observe your symptoms or
condition without using medical treatment. Because of the need to prevent the
spread of hepatitis B, watchful waiting isn't advised if you have symptoms
of the virus or if you think you have come in contact with the
virus.

Exams and Tests

Your doctor will
diagnose
hepatitis B based on a physical
exam and blood tests. He or she also will ask about your medical history (including possible risks for the virus, such as your job and sexual activity).

Blood tests to diagnose hepatitis B

Blood
tests are done to help diagnose hepatitis B. They include:

Hepatitis B
antigens and
antibodies. These help tell
if you are or were infected with the virus. They also can show if you have been immunized
and if you have long-term (chronic) infection.
You also may get tested for the virus's genetic material (HBV DNA).
For more
information, see Hepatitis B Virus Tests.

Test for liver cancer

Follow-up visits

If you have
chronic infection, you will need to visit your doctor
regularly. He or she will do blood tests to check your liver function and the
activity of the virus in your body.

Some of the tests can tell your
doctor if the virus is multiplying in your liver. This raises your risk for chronic
hepatitis.

Early detection

The Centers for Disease Control and Prevention (CDC) recommends that all pregnant women have
the hepatitis B surface antigen test. The test can show if a woman has a current hepatitis B infection. This test also may be repeated later in the pregnancy if
a woman is at high risk for infection.

You can be tested for
hepatitis B before getting vaccinated.

Antibody testing will show if you have an active hepatitis B infection and need treatment.

If testing shows that you are already protected against hepatitis B, you won't need to get the hepatitis B vaccine(What is a PDF document?).

It's not harmful to get the
vaccine even if you already have antibodies against the virus in your
blood.

Treatment Overview

Treatment of
hepatitis B infection depends on how
active the virus is and whether you are at risk for liver damage such as
cirrhosis.

Treatment of short-term (acute) hepatitis B

Treatment depends on whether you:

Have been recently infected with the virus.

Have the symptoms of an acute
infection.

Have chronic infection.

If you have not gotten a hepatitis B vaccine and think you may have been exposed to the virus, you
should get a shot of
hepatitis B immunoglobulin (HBIG) and the first of
three shots of
the hepatitis B vaccine(What is a PDF document?). It is important to receive this treatment within 7 days
after a needle stick and within 2 weeks after sexual contact that may have
exposed you to the virus. The sooner you receive treatment after exposure, the
better the treatment works.

If you have the symptoms of acute
infection, treatment with antiviral medicine usually isn't needed. Home treatment—such as eating well, drinking plenty of fluids, and avoiding alcohol and drugs—
usually will relieve your symptoms.

In some cases, you
may be given medicine to treat an acute infection. But using medicine usually isn't done unless a person is very sick.

Treatment of long-term (chronic) hepatitis B

Treatment depends on how active the
virus is in your body and your chance of liver damage. The goal of treatment
is to stop liver damage by keeping the virus from multiplying.

Antiviral medicine is used if the virus is active and you are at risk
for liver damage. Medicine slows the ability of the virus to multiply.

Antiviral treatment isn't given to everyone who
has chronic hepatitis B.

Don't get a tattoo unless you are sure the needles have been cleaned properly and are sterile.

Hepatitis B vaccine

The
hepatitis B vaccine is the most effective way to prevent infection. The
vaccine is up to 95% effective against hepatitis B if you receive all the
shots in the vaccination series (3 or 4 shots given at different times).2

Vaccination is recommended for certain groups of people(What is a PDF document?), such as health professionals, people who have more than one sex partner, and people who have certain illnesses.

Discuss vaccination with your
doctor even if you aren't in one of the recommended groups.
In the United States, about 15 out of 100 of those who become infected don't
know how they got infected.4

In some
cases, a doctor will order
postvaccination testing to make sure you have
developed immunity to the virus. People who need this testing
include those who have an
impaired immune system or those who are health care
workers or sex partners of people who have chronic
infection.

If you are exposed to the virus before you have
received all of the shots in the vaccination series, you may be given a dose of
hepatitis B immunoglobulin (HBIG) soon afterward. In
most cases, this will prevent infection until the vaccine takes effect.

If you have had sex with someone who has hepatitis B and you haven't
received all doses of the hepatitis B vaccine, you should receive a shot of
HBIG—in addition to continuing the vaccine series—within 14 days of being
exposed to the virus.

Avoiding spreading the virus if you have it

If you are
already infected, you can take steps to
prevent spreading the virus to others. This includes not
donating blood and not sharing razors or other toiletries.

Home Treatment

Home treatment can help
relieve symptoms and prevent the spread of
hepatitis B virus (HBV).

Slow down

Reduce your activity to match your
energy. You don't have to stay in bed, but listen to your body. Slow
down when you are tired.

If you are feeling tired at work or school, try to reduce your
workload.

Avoid strenuous
exercise.

As you start to feel better, slowly go back to your regular
activities. If you try to go back to your regular pace too soon, you may
get sick again.

Eat right

Even though food may not appeal to you, it is
important to eat well. For most people, nausea and loss of
appetite become worse as the day goes on. Try eating a substantial (but not
heavy) meal in the morning and lighter meals later in the
day.

Doctors used to recommend a high-calorie,
protein-rich diet to people who have hepatitis. This is no longer believed to
help. And such foods can be hard to eat when you feel nauseated.
Try to have a balanced diet while eating foods that appeal to you.

Avoid dehydration

It is important to keep
your body well-hydrated when you have hepatitis B, especially if you have been
vomiting.

Drink plenty of water.

If you can
tolerate them, fruit juices and broth are other good choices, because they
provide extra calories.

Many of the "sports drinks" available
in grocery stores can help replace essential minerals (electrolytes)
that are lost during vomiting. You can also make your own
rehydration drink.

Avoid alcohol and drugs

Hepatitis makes it hard for your liver to process drugs and alcohol. If you take drugs (prescription
or illegal) or drink alcohol when you have hepatitis, their effects may be more
powerful and may last longer. They also can make
liver damage worse.

If you are taking prescription medicines,
your doctor may tell you to stop using them until your
liver has had time to heal. Don't stop taking the medicines unless
your doctor has told you to do so.

Check with
your doctor before taking any over-the-counter medicines, including herbal products
and acetaminophen (such as Tylenol). Acetaminophen can make liver disease
worse, especially if you continue to drink alcohol.

Avoid alcohol until your doctor feels that your liver is
completely healed. This may take as long as 3 to 4 months.

Try to control itching

People who have hepatitis
sometimes have itchy skin. You can
control itching by keeping cool and out of the sun,
wearing cotton clothing, or using over-the-counter antihistamines such as Benadryl
or Chlor-Trimeton. Talk to your doctor before taking these medicines.

Medications

Treatment with medicine usually isn't recommended for people who have acute
hepatitis B. Antiviral medicine may be used for chronic infection if the virus is multiplying. You also may take medicine if you have liver damage, such as
cirrhosis, or could develop it.

Antiviral therapy may not help if you
already have severe liver damage.

The American Association for
the Study of Liver Disease has made
recommendations on who should receive antiviral
treatment for chronic hepatitis B.5

It's important to weigh the benefits of
treatment against the risks. Treatment for chronic hepatitis B doesn't cure
the disease, but it does suppress it.

What to think about

Interferons have common side
effects, including fever, headaches, and hair loss. They may also cause mental problems or make them worse.

If you have cirrhosis, you cannot use interferons. But
you can use adefovir, entecavir, lamivudine, telbivudine, and tenofovir.

After
any kind of treatment for hepatitis B, the virus may become active again (relapse).

Surgery

There is no surgical treatment for
hepatitis B.

If you have advanced liver damage because of
hepatitis and your condition becomes life-threatening, you may need a
liver transplant.

In rare cases,
acute hepatitis B progresses rapidly to liver failure, a
deadly condition called
fulminant hepatitis. For people who develop this condition, a liver
transplant is the only treatment choice.

Other Treatment

Some people who have acute
hepatitis B have severe nausea and
dehydration. If this happens, you might need to stay in the hospital so you can receive fluids
intravenously.

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